Provider Demographics
NPI:1093397283
Name:HORTON, JESSICA (NBC- HWC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:NBC- HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-9777
Mailing Address - Country:US
Mailing Address - Phone:816-529-7148
Mailing Address - Fax:
Practice Address - Street 1:1916 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1803
Practice Address - Country:US
Practice Address - Phone:913-297-7472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date: